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Monday, April 29, 2013

Health Reform, ACA, Medicaid, Congress and the Edsel

Time is marching on towards January 2014, the next date for implementation of the major stages of the Affordable Care Act. There are those who live in denial hoping for the best and those who realize the tsunami is on it’s way. Like Tsunami’s the water rushing out does more damage than coming on shore.’

The initial incoming wave will be the increase of previously uninsured entering the system. Not only will there be more patients, they will be the sickest with more problems, more chronic illnesses, previously undiagnosed, untreated and at more advance stages of their illnesses.

As the wave rushes in it will inundate the health system, peak and then rush out, sucking with it the vestiges of the old system. There will be many innocent bystanders, rich and poor, and only the ones standing on the highest ground will not be effected.

Congress, Fearing 'Brain Drain,' Seeks to Opt Out of Participating in Obamacare's Exchanges

Exchanges are crucial to the future of health reform

The idea was simple: that if Congress was going to impose Obamacare upon the country, it should have to experience what it is imposing firsthand. But now, word comes that Congress is quietly seeking to rescind that provision of the law, because members fear that staffers who face higher insurance costs will leave the Hill.

While I have many friends who work for Congress, and I wish them well, it is absolutely a good thing that members and staffers are enrolled on the exchange. It is vital for these individuals to experience, first-hand, how Obamacare’s costly mandates and regulations will drive up the price of health insurance. Staffers will, in particular, be affected by Obamacare’s “community rating” provision, which jacks up the cost of insurance for young people. (Most Hill staffers are in their twenties and early thirties.)

Sen. Grassley’s original idea was to require all federal employees to enroll in the exchanges, instead of in the Federal Employee Health Benefits Program, where most gain coverage today. Indeed, a previous Senate Finance Committee amendment proposed putting members and staffers on Medicaid. But “fierce opposition from federal employee unions” sank Grassley’s effort, and he had to water his amendment down to only apply to Congress and congressional staff.

Even those in CMS are worried;

CMS on Obamacare's Health Insurance Exchanges: 'Let's Just Make Sure It's Not a Third-World Experience'

Increasingly, officials in the Obama administration are worried that the rollout of the exchanges will be chaotic, given the law’s complexity and unrealistic deadlines. “We are under 200 days from open enrollment” on the exchanges, noted Henry Chao, deputy chief information officer at the Centers for Medicare and Medicaid Services, at a recent conference. “I’m pretty nervous—I don’t know about you.”

Rate shock is a bigger danger than implementation

It’s almost certain that the rollout of the exchanges will be choppy, in terms of the user experience, the Byzantine application process, and the degree to which insurance plans are capable of formulating their products on time, given how late HHS has been at giving regulatory guidance to carriers. But while exchanges are complicated to set up, it’s not an impossible task; after all, Massachusetts has had an Obamacare-like exchange for years.

“In some markets,” said Aetna’s CEO, Mark Bertolini, insurance premiums could increase “as high as 100 percent. And we’ve done all that math. We’ve shared it with all the regulators. We’ve shared it with all the people in Washington that need to see it. And I think it’s a big concern.” Privately and publicly, most of Bertolini’s peers at UnitedHealth, WellPoint, Humana, and Cigna have said the same thing.

It seems incredulous that Congress would invoke a “WalMart’ feature to insure those who work for our federal government. Imagine the most powerful nation in the world insuring their government workers through medi-caid.

Medi-caid has such a bad name that no matter what was done to it it’s still the Edselof health systems.

Disclaimer

The opinions in this blog or other forms of social media are solely that of Gary M. Levin M.D. Dr. Levin has no financial interests in any medical devices which are discussed or which appear in the blog. Commentary taken from other sources are either quoted or referenced with attribution. Dr Levin does not endorse, nor give financial support to any political organizations.